54 year-old female presents because of hives. She was seen by me in October for a
physical exam and UTI but actually never took the antibiotic because her symptoms
resolved before she started it. At the end of October she developed hives initially with
occasional welts, subsequently much worse on December 22, possibly after eating
persimmons. She was seen by Steve Johnson, given Zyrtec which she found helpful and
continues to use as needed. On January 22 while in Hawaii she had a flare of hives after
eating papaya which also caused some nausea and vomiting. The hives were quite severe
and have been more severe since then with patches on her arms, legs, chest and back that
are fairly itchy. She has been taking Zyrtec daily for one week, uses Allegra in addition
if severe. She was under some stress last week from a school event but does not think
that this is a reaction to stress. She has not started Actonel because of this problem and
tried stopping all vitamins. She is currently on no medications except the Zyrtec and
Allegra.
EXAMINATION: BP 112/80, P 84. Patches of raised red lesions on her thighs and
back. Full exam was not repeated as it was done last fall.
IMPRESSION: Urticaria, possible culprits include papaya and persimmons.
PLAN: RAST testing for papaya and persimmons. Continue Zyrtec as needed. Add
Zantac 150 mg bid as needed. Discussed consultation with allergy if symptoms do not
resolve.